Provider Demographics
NPI:1730133323
Name:WOODSON, RONALD G (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:G
Last Name:WOODSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 NW ARLINGTON
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505
Mailing Address - Country:US
Mailing Address - Phone:580-250-4278
Mailing Address - Fax:580-581-1548
Practice Address - Street 1:3106 NW ARLINGTON
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505
Practice Address - Country:US
Practice Address - Phone:580-250-4278
Practice Address - Fax:580-581-1548
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11832207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200069590AMedicaid
OK200069590AMedicaid
D42947Medicare UPIN